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The area is one of four de-escalation zones set up earlier this year as part of an internationally brokered ceasefire deal, but opposition activists and charities on the ground say bombings have intensified in recent weeks.

Hospitals have been destroyed, and lacking basic equipment, doctors are taking desperate measures to care for the wounded.

“All of the medical supplies that usually have to be used only one time for instance here in Europe or in France or in any other country, over there they’re just trying to clean them,” Mohammad Alolaiwy, president of the France-based Syria Charity, told Euronews in an interview.

“All medical supplies – you can imagine, for surgery, for everything, they are always reused. And they are of course not able to sterilise them properly.”

Syria Charity’s ambulance working in eastern Ghouta has already been hit twice by bombings, he said.

Such photos have caused outrage, and a UN convoy entered the enclave of eastern Ghouta last week for the first time since June 2016, carrying aid for 40,000 people.

“This is absolutely not enough – this is almost nothing,” Alolaiwy said. “The NGOs working on the ground have been able to enter food supplies way more than this UN convoy – through tunnels, through other ways. This is absolutely not enough. We need a proper humanitarian response to let all the NGOs enter this area and be able to do their jobs.”

The fact the Syrian army this week declared victory over the Islamic State militant group has fueled fears of an even tougher crackdown on remaining opposition strongholds like Ghouta.

“The fear is that now the Syrian regime forces have defeated Islamic State in the eastern zone, now they are going to concentrate on Ghouta, on the Damascus suburbs, to eradicate everything – to do exactly what has been done in Aleppo a few months ago,” Alolaiwy said.

Eastern Ghouta was hit in 2013 by a devastating chemical attack that sparked international outrage.

Today there are concerns that daily living conditions could get even worse as winter closes in and temperatures drop.

The UN’s Egeland stressed that the population has been through seven years of war, longer than World War II.

“With little, if any, reserves, no heat in their houses and living amid ruin, [for them] it will be a horrific winter,” he warned.